Untying the Tubes: Reversal Rate Is Rising

When Cathy and Craig Gurney of Ontario got married in 1981, they knew they would not be having any children. After all, during her previous marriage, Gurney had undergone a tubal ligation seven months after the birth of her son, Gerrit.

Gurney, 35, said she decided to have the operation in 1977, "mainly because my first husband didn't want any children; he had been married before and had a son." She was unable to use an IUD or take birth control pills for health reasons, she said, and that left only two options--a vasectomy for her husband or tubal ligation for her.

'Him or Me'

"So," Gurney recalled, "the choice was him or me, and somehow we decided on me."

At the time, having her tubes tied seemed like the right thing to do, Gurney said, but "I didn't count on my husband leaving and remarrying."

Nor did she anticipate the emotional repercussions of the procedure. "Seeing other women who had children and knowing I could never do it again, I took it really hard," Gurney said. And after getting remarried, she said, the idea of not having any children with her new husband was even harder to take.

"It made it like an obsession that I would want to give him his own child," she said. "There's just something about being able to share that."

Gurney is not alone.

A small but statistically significant number of women who have tubal ligations--a procedure in which the Fallopian tubes are cut or blocked so the egg cannot meet sperm and be fertilized--have serious second thoughts about having chosen what is designed to be a permanent form of sterilization.

As Gurney discovered, however, there is a surgical technique to reverse a tubal ligation. The procedure is called tubal reanastomosis, better known as the reversal of tubal ligations.

Although reversals have been performed for years with conventional surgery, the chance of success--as measured by the delivery of a healthy baby--was only 20% to 30% before the advent of microsurgery a decade ago. Since then, the chance of success has increased dramatically--to as high as 80%.

Of the estimated 650,000 American women who undergo tubal ligations each year, about 5% have the procedure reversed, according to Dr. Jordan M. Phillips of Santa Fe Springs, chairman of the board of the American Assn. of Gynecological Laparoscopists.

'Regret Level'

"We call it the regret level," Phillips said, noting that there is no way of knowing the exact number of women who have reversals. "Some doctors do a large number of cases; others do not, and there is no way of knowing." But, he added: "The number is increasing. Now there are doctors spending their whole time doing this."

Not all women who have undergone tubal ligations are aware that the procedure can be reversed, said Dr. Ari Babaknia, founder and director of the California Infertility Institute in Santa Ana who performed about 40 reversals last year. Based on his experience, Babaknia said, "maybe 80% of women don't know this can be reversed." And, he added, "some doctors don't even know it's possible."

Dr. Sergio Stone, director of the division of infertility at UC Irvine Medical Center, acknowledged that some of his reversal patients have been told by doctors that their tubal ligations cannot be reversed. But, said Stone, who performs about four reversals a month (the same number he's been doing for the past 10 years), "even in the worst cases we can give a patient a 30% chance, unless there has been total destruction of the tube."

Phillips said most women give a lot of thought to having their tubes tied, "but their lives change and as their life situation changes, their fertility requirements may change." As a result, he said, these women are highly motivated to have a baby.

In a survey Babaknia conducted last year to find out why his patients wanted a reversal, he discovered that the majority--about 62%--had remarried and wanted a child with their new husband.

Suffered Tragedies

"The rest of them had some tragedies in their lives in which they lost their children; we had five patients who had crib deaths," he said. "We also had a very interesting group of patients who had some kind of emotional or psychological problem after tying their tubes; they felt kind of guilty that they did it, that they terminated the function of their body."

Seven patients, Babaknia added, "were with the same husband, but they simply wanted more children."

Unlike a tubal ligation--usually a 20- to 30-minute operation that can be performed on an outpatient basis--a reversal is major abdominal surgery, requiring a two- to three-hour operation and about three or four days of hospitalization in addition to a couple of weeks recovery at home, according to Babaknia. A reversal is also more expensive, he said, costing $5,000 to $6,000 (for surgical fees and hospitalization) compared to about $1,500 for a tubal ligation done on an outpatient basis.